Healthcare Provider Details

I. General information

NPI: 1790951259
Provider Name (Legal Business Name): LAILA ESDEN M.S./CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7605 CONROY WINDERMERE RD
ORLANDO FL
32835-2646
US

IV. Provider business mailing address

7605 CONROY WINDERMERE RD
ORLANDO FL
32835-2646
US

V. Phone/Fax

Practice location:
  • Phone: 407-291-9393
  • Fax: 407-291-9699
Mailing address:
  • Phone: 407-291-9393
  • Fax: 407-291-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 1882
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: